Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2008 Feb;43(1):1-8. Korean.
    Published online Feb 29, 2008.
    https://doi.org/10.4055/jkoa.2008.43.1.1
    Copyright © 2008 The Korean Orthopaedic Association
    Original Article

    Clinical Results of Autoiliac Cancellous Bone Graft Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head

    Joon Soon Kang, M.D., Kyong Ho Moon, M.D., Seung Rim Park, M.D., Seok Bong Kang, M.D., Hae Bong Park, M.D. and Sang Hyup Lee, M.D.
      • Department of Orthopedic Surgery, In-Ha University Hospital, Incheon, Korea.
    • Address reprint requests to Joon Soon Kang, M.D. Department of Orthopaedic Surgery, Inha University Hospital, 7-206, Shinheung-dong 3-ga, Jung-gu, Incheon 400-103, Korea. Tel: +82.32-890-3565, Fax: +82.32-890-3047, Email: Kangjoon@inha.ac.kr

    Abstract

    Purpose

    We prospectively analyzed the clinical results of auto-iliac cancellous bone graft with autologous bone marrow mononucleated cell implantation for osteonecrosis of the femoral head.

    Materials and Methods

    In a prospective evaluation, 45 hips in 37 patients with osteonecrosis of the hip were treated with auto-iliac cancellous bone graft after core decompression combined with implantation of autologous bone marrow cells. The average duration of clinical follow up of the patients was 32 months. Core decompression of the femoral head was performed and most of the necrotic part of the head was removed. Auto-iliac cancellous bone grafting was then done to fill up the defect, and this was followed by cell therapy with implantation of autologous monocytes isolated from the iliac bone marrow.

    Results

    The mean Merle d' Aubigne and Postel score improved from 11.6 points preoperatively to 15.5 points. Collapse of the femoral head developed in 13 hips, of which 12 hips showed an extensive lesion on the preoperative radiogram. Total hip replacement surgery was performed in 9 hips: 8 hips were due to progressive collapse of the femoral head with clinical deterioration, and 1 hip was due to postoperative bacterial infection. The preoperative stages of the 8 hips that were converted to THRA were stage II in 1 hip, stage III in 4 hips and stage IV in 3 hips. The head preservation rate according to the preoperative stage was 94.4% in stage II, 77.8% in stage III and 66.7% in stage IV.

    Conclusion

    Auto-iliac cancellous bone grafting combined with implantation of autologous bone marrow cells after core decompression showed a good clinical results on the short term follow-up. Long term follow-up studies are still necessary to validate this point.

    Keywords
    Hip; Osteonecrosis; Bone marrow implantation; Bone graft

    Figures

    Fig. 1
    (A, B) Preoperative plain radiographs and MRI of 45-year-old male patient shows large osteonecrosis of left femoral head. (C) At 1 year after surgery, crescent sign was found. (D) Radiograph of postoperative 3 years shows the change of head contour and head depression less than 1 mm. However, he did not have any difficulty in activity and clinical result was excellent.

    Fig. 2
    (A, B) A radiography and an MRI of a 32-year-old male patient showed alcohol-induced osteonecrosis of stage III (severe lesion). (C) Postoperative 6 months radiograph shows minimal change of head contour and crescent sign. (D) Radiograph of postoperative 28 months shows the head depression about 1 mm. However, he can do full ordinary activity without pain.

    Tables

    Table 1
    The Merle d'Aubigne Postel Score Change before and after Operation

    References

      1. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am 1986;68:1313–1319.
      1. Merle D'Aubigne R, Postel M, Mazabraud A, Massias P, Gueguen J, France P. Idiopathic necrosis of femoral head in adults. J Bone Joint Surg Br 1965;47:612–633.
      1. Engh CA, Gloss FE, Bobyn JD. Biologic fixation arthroplasty in the treatment of osteonecrosis. Orthop Clin North Am 1985;16:771–787.
      1. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985;67:3–9.
      1. Ficat RP, Arlet J. In: Ischemia and necrosis of bone. Boltimore, London: Williams and Wilkins; 1980.
      1. Ficat RP, Arlet J. Treatment of bone ischemia and necrosis. In: Hungerford DS, Mont MA, editors. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins; 1980. pp. 171-182.
      1. Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone marrow cells. A pilot study. J Bone Joint Surg Am 2004;86:1153–1160.
      1. Gangji V, Hauzeur JP, Schoutens A, Hinsenkamp M, Appelboom T, Egrise D. Abnormalities in the replicative capacity of osteoblastic cells in the proximal femur of patients with osteonecrosis of the femoral head. J Rheumatol 2003;30:348–351.
      1. Gardeniers JW. A new international classification of osteonecrosis of the ARCO-committee on terminology and classification. ARCO News 1992;4:41–46.
      1. Hernigou P, Beaujean F. Abnormality in the bone marrow of the iliac crest in patients who have necrosis secondary to corticosteroid therapy or alcohol abuse. J Bone Joint Surg Am 1997;79:1047–1053.
      1. Hernigou P, Beaujean F. Treatment of Osteonecrosis With Autologous Bone Marrow Grafting. Clin Orthop Relat Res 2002;405:14–23.
      1. Hernigou P, Bachir D, Galacteros F. The natural history of symptomatic osteonecrosis in adults with sickle-cell disease. J Bone Joint Surg Am 2003;85:500–504.
      1. Hernigou P, Beaujean F, Lambotte JC. Decrease of mesenchymal stem-cell pool in the proximal femur in cokticosteroid induced osteonecrosis. J Bone Joint Surg Br 1999;81:349–355.
      1. Hungerford DS, Mont MA. The Role of Core Decompression in the Treatment of Osteonecrosis of the Femoral Head. In: Urbaniak JR, Jones JP, editors. Osteonecrosis: etiology, diagnosis and treatment. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1997. pp. 287-292.
      1. Hungerford DS, Zizic TM. In: The hip proceeding of the eleventh open scientific meeting of The Hip Society. ST Louis, Toronto: CV Mosby; 1983. Pathogenesis of ischemic necrosis of the femoral head; pp. 219-262.
      1. Katz RL, Bourne RB, Rorabeck CH, McGee H. Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations. Clin Orthop Relat Res 1992;281:145–151.
      1. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho Sh. Preventing collapse in early osteonecrosis of the femoral head. A randomized clinical trial of core decompression. J Bone Joint Surg Br 1995;77:870–874.
      1. Launder WJ, Hungerford DS, Jones LH. Hemodynamics of the femoral head. J Bone and Joint Surg Am 1981;63:442–448.
      1. Marcus ND, Enneking WF, Massam RA. The silent hip in idiopathic aseptic necrosis: Treatment by bone grafting. J Bone Joint Surg Am 1973;55:1351–1366.
      1. Merle d'Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451–475.
      1. Mont MA, Etienne G, Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 2003;417:84–92.
      1. Mont MA, Marulanda GA, Seyler TM, Plate JF, Delanois RE. Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head. Instr Course Lect 2007;56:213–220.
      1. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995;77:459–474.
      1. Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect 2000;49:169–185.
      1. Park HC, Shim YS, Ha Y, et al. Treatment of complete spinal cord injury patients by autologous bone marrow cell transplantation and administration of granulocyte-macrophage colony stimulating factor. Tissue Eng 2005;11:913–922.
      1. Rijnen WH, Gardeniers JW, Buma P, Yamano K, Slooff TJ, Schreurs BW. Treatment of femoral head ostenecrosis using bone impaction grafting. Clin Orthop Relat Res 2003;417:74–83.
      1. Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hariman KM. Does lesion size affect the outcome in avascular necrosis. Clin Orthop Relat Res 1999;367:262–271.
      1. Steinberg ME, Larcom PG, Strafford B, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 2001;386:71–78.
      1. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995;77:34–41.
      1. Stulberg BN, Davis AW, Bauer TW, L'evien M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res 1991;268:140–151.
      1. Suh KT, Kim SW, Roh HL, Youn MS, Jung JS. Decreased osteogenic differenciation of mesenchymal stem cells in alchol-induced osteonecrosis. Clin Orthop Relat Res 2005;431:220–225.
      1. Yoon TR, Song EK, Rowe SM, Park CH. Failure after core decompression in osteonecrosis of femeral head. Int Orthop 2001;24:316–318.
    Cited by
    Crossref 5
    Google Scholar 
    MeSH Terms
    Arthroplasty, Replacement, Hip
    Bacterial Infections
    Bone Marrow
    Bone Marrow Cells
    Bone Transplantation
    Decompression
    Follow-Up Studies
    Head
    Hip
    Humans
    Monocytes
    Osteonecrosis
    Prospective Studies
    Tissue Therapy
    Transplants
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide

    1 / 1

    PERMALINK